Media captionMental health patients 'smoke three times as much', a survey suggests

Mental health patients smoke more than three times as much as the general population, a Public Health England and NHS survey of 105 care units suggests.

Smoking can increase depression and anxiety and reduce the effectiveness of medication by up to 50%, experts warn.

PHE wants all mental-health hospitals to be smoke-free zones.

But smokers' rights group Forest says patients in mental health units should have the same freedom to smoke as the general public.

The PHE survey suggests 64% of mental-health patients are addicted to tobacco - compared with 18% of the general population, although 9% of the units are already completely smoke-free.

It is publishing new guidance to help medium- and low-security mental-health units implement National Institute for Clinical Excellence (NICE) recommendations that all NHS-funded hospitals should provide stop-smoking services.

Experts say smoking is the main reason mental-health patients have a life expectancy that is 10 to 20 years lower,

Kevin Fenton, PHE national director of health and wellbeing said the organisation wanted to "reduce the unacceptable inequalities in health experienced by people living with mental-health problems".

Mary Yates, matron of London's Maudsley Hospital - who has worked in mental-health care for more than 25 years - said: "It's been commonplace for smoking to be facilitated - for nurses to purchase cigarettes for patients, to accommodate patients cigarette breaks and to escort people to smoke rather than to be investing energy in educating people on the harmful effects of smoking."

She said those effects were not just damage to physical health, which people were usually aware of - but that there was also the growing evidence that smoking cessation enhances people's mental wellbeing.

Ms Yates added: "People who are able to successfully give up smoking feel less anxious, have improvements in their moods, have increased self-confidence, and begin to feel that they are able to tackle a lot more in life."

Garry Ellison, who quit smoking in 2003 after being admitted to a mental-health care unit for depression, said: "I do now feel a lot more serenity and at ease - there used to be a thing when I was a smoker and I was always waiting for my fag break - so I'd be here talking to you thinking, 'Oh right, when I'm finished I'll be straight out of here having a fag.'

It made me much more prone to be anxious, which then brought on depressionGarry Ellison,, Ex-smoker

"And after eating, I'd have a cigarette. In the morning, I'd have a cigarette with a coffee. It seemed to punctuate the day, and there's a feeling of not having to do that.

"I think I've got a much better, robust sense of being able to maintain my wellbeing.

"Smoking made that much more precarious.

"It made me much more prone to be anxious, which then brought on depression."

But former mental-health patient Gary Nevan said it was "out of order" for service users to be told what to do.

He said: "We're in hospital to get better, and sometimes having a fag makes you feel good, so I don't appreciate being told I can't light up when I can at home. We're not kids."

Cutting costs

A Royal College of Physicians report says that, in contrast to a marked decline among the general population, smoking rates among those with mental disorders have changed little, if at all, during the past 20 years.

If some mental health patients enjoy smoking why should they be denied that pleasure?Simon Clark,, Forest

It says there are up to three million smokers in the UK, and about 30% of them are thought to have a mental disorder.

It also estimates smoking increases psychotropic drug costs in the UK by up to £40m per annum.

It says: "Addressing the high prevalence of smoking in people with mental disorders offers the potential to realise substantial cost savings to the NHS, as well as benefits in quantity and quality of life."

But Simon Clark, director of the smokers' group Forest, said: "Smoking is not just about health, although many smokers believe it helps reduce anxiety and stress. If some mental health patients enjoy smoking why should they be denied that pleasure?

"Public Health England has no right to deny people choice. Who are they to dictate whether or not a mental health patient can smoke a product that is legally available to every other adult in Britain?

"What PHE is proposing is discrimination. It will target unfairly a group of people who, being dependent on others, has little alternative other than to comply."